IntroductionAboriginal and Torres Strait Islander peoples are Australia’s first peoples and have been connected to the land for ≥65 000 years. Their enduring cultures and values are considered critical to health and wellbeing, alongside physical, psychological and social factors. We currently lack large-scale data that adequately represent the experiences of Aboriginal and Torres Strait Islander people; the absence of evidence on cultural practice and expression is particularly striking, given its foundational importance to wellbeing.Method and analysisMayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing (Mayi Kuwayu Study) will be a large-scale, national longitudinal study of Aboriginal and Torres Strait Islander adults, with linkage to health-related administrative records. The baseline survey was developed through extensive community consultation, and includes items on: cultural practice and expression, sociodemographic factors, health and wellbeing, health behaviours, experiences and environments, and family support and connection. The baseline survey will be mailed to 200 000 Aboriginal and Torres Strait Islander adults (≥16 years), yielding an estimated 16 000–40 000 participants, supplemented through face-to-face recruitment. Follow-up surveys will be conducted every 3–5 years, or as funding allows. The Mayi Kuwayu Study will contribute to filling key evidence gaps, including quantifying the contribution of cultural factors to wellbeing, alongside standard elements of health and risk.Ethics and disseminationThis study has received approval from national Human Research Ethics Committees, and from State and Territory committees, including relevant Aboriginal and Torres Strait Islander organisations. The study was developed and is conducted in partnership with Aboriginal and Torres Strait Islander organisations across states and territories. It will provide an enduring and shared infrastructure to underpin programme and policy development, based on measures and values important to Aboriginal and Torres Strait Islander peoples. Approved researchers can access confidentialised data and disseminate findings according to study data access and governance protocols.

Indigenous Australians experience profound levels of disadvantage in health, living standards, life expectancy, education and employment, particularly in comparison with non-Indigenous Australians. Very little information is available about the healthy development of Australian Indigenous children; the Longitudinal Study of Indigenous Children (LSIC) is designed to fill this knowledge gap.This dataset provides an opportunity to follow the development of up to 1759 Indigenous children. LSIC conducts annual face-to-face interviews with children (aged 0.5–2 and 3.5–5 years at baseline in 2008) and their caregivers. This represents between 5% and 10% of the total population of Indigenous children in these age groups, including families of varied socioeconomic and cultural backgrounds. Study topics include: the physical, social and emotional well-being of children and their caregivers; language; culture; parenting; and early childhood education.LSIC is a shared resource, formed in partnership with communities; its data are readily accessible through the Australian Government Department of Social Services (see http://dss.gov.au/lsic for data and access arrangements). As one of very few longitudinal studies of Indigenous children, and the only national one, LSIC will enable an understanding of Indigenous children from a wide range of environments and cultures. Findings from LSIC form part of a growing infrastructure from which to understand Indigenous child health.

In Australia and internationally, there are increasing calls for the use of strengths-based methodologies, to counter the dominant deficit discourse that pervades research, policy, and media relating to Indigenous health and wellbeing. However, there is an absence of literature on the practical application of strengths-based approaches to quantitative research. This paper describes and empirically evaluates a set of strategies to support strengths-based quantitative analysis. A case study about Aboriginal and Torres Strait Islander child wellbeing was used to demonstrate approaches to support strengths-based quantitative analysis, in comparison to the dominant deficit approach of identifying risk factors associated with a negative outcome. Data from Wave 8 (2015) of the Australian Longitudinal Study of Indigenous Children were analysed. The Protective Factors Approach is intended to enable identification of factors protective against a negative outcome, and the Positive Outcome Approach is intended to enable identification of factors associated with a positive health outcome. We compared exposure-outcome associations (prevalence ratios and 95% confidence intervals (CIs), calculated using Poisson regression with robust variance) between the strengths-based and deficit approaches. In this case study, application of the strengths-based approaches retains the identification of statistically significant exposure-outcome associations seen with the standard deficit approach. Strengths-based approaches can enable a more positive story to be told, without altering statistical rigour. For Indigenous research, a strengths-based approach better reflects community values and principles, and it is more likely to support positive change than standard pathogenic models. Further research is required to explore the generalisability of these findings.

Objective: To quantify absolute cardiovascular disease (CVD) risk and treatment in Australian adults. Design, participants: Cross‐sectional representative study of 9564 people aged 18 years or more who had participated in the 2011–12 Australian National Health Measures Survey (response rate for those aged 45–74 years: 46.5%). Main outcome measures: Prior CVD was ascertained and 5‐year absolute risk of a primary CVD event calculated (using the Australian National Vascular Disease Prevention Alliance algorithm; categories: low [< 10%], moderate [10–15%], and high [> 15%] risk) on the basis of data on medical history, risk factors and medications, derived from interviews, physical measurements, and blood and urine samples. Results: Absolute CVD risk increased with age and was higher among men than women. Overall, 19.9% (95% CI, 18.5–21.3%) of Australians aged 45–74 years had a high absolute risk of a future CVD event (an estimated 1 445 000 people): 8.7% (95% CI, 7.8–9.6%) had prior CVD (estimated 634 000 people) and 11.2% (95% CI, 10.2–12.2%) had high primary CVD risk (estimated 811 000 people). A further 8.6% (95% CI, 7.4–9.8%, estimated 625 000) were at moderate primary CVD risk. Among those with prior CVD, 44.2% (95% CI, 36.8–51.6%) were receiving blood pressure‐ and lipid‐lowering medications, 35.4% (95% CI, 27.8–43.0%) were receiving only one of these, and 20.4% (95% CI, 13.9–26.9%) were receiving neither. Corresponding figures for high primary CVD risk were 24.3% (95% CI, 18.3–30.3%); 28.7% (95% CI, 22.7–34.7%); and 47.1% (95% CI, 39.9–54.3%). Conclusions: About one‐fifth of the Australian population aged 45–74 years (about 1.4 million individuals) were estimated to have a high absolute risk of a future CVD event. Most (estimated 970 000) were not receiving currently recommended combination blood pressure‐ and lipid‐lowering therapy, indicating substantial potential for health gains by increasing routine assessment and treatment according to absolute CVD risk.

Background Despite generally high smoking prevalences, stemming from colonization, the relationship of smoking to mortality has not been quantified reliably in an Indigenous population. We investigate smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia, where current adult daily smoking prevalence is 40.2%. Methods A prospective study of 1388 cardiovascular disease- and cancer-free Aboriginal adults aged ≥45 years, of the 267 153 45 and Up Study participants randomly sampled from the New South Wales general population over 2006–09. Questionnaire and mortality data were linked (through the Centre for Health Record Linkage) to mid-2019. Adjusted hazard ratios (called relative risks, RRs) for all-cause mortality—among current- and past- versus never-smokers—were estimated overall, by smoking intensity and by age at cessation. Smoking-attributable fractions and associated deaths were estimated. Results Over 14 586 person-years’ follow-up (median 10.6 years), 162 deaths accrued. Mortality RRs [95% confidence interval (CI)] were 3.90 (2.52–6.04) for current- and 1.95 (1.32–2.90) for past- versus never-smokers, with age heterogeneity. RRs increased with smoking intensity, to 4.29 (2.15–8.57) in current-smokers of ≥25 cigarettes/day. Compared with never-smokers, RRs were 1.48 (0.85–2.57) for those quitting at &lt;45 years of age and 2.21 (1.29–3.80) at 45–54 years. Never-smokers lived an average &gt;10 years longer than current-smokers. Around half of deaths among adults aged ≥45 years were attributable to smoking, exceeding 10 000 deaths in the past decade. Conclusions In this population, &gt;80% of never-smokers would survive to 75 years, versus ∼40% of current-smokers. Quitting at all ages examined had substantial benefits versus continuing smoking; those quitting before age 45 years had mortality risks similar to never-smokers. Smoking causes half of deaths in older Aboriginal and Torres Strait Islander adults; Indigenous tobacco control must receive increased priority.